Provider Demographics
NPI:1760290431
Name:BUTTRY, DANIEL DWAYNE I
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DWAYNE
Last Name:BUTTRY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:OK
Mailing Address - Zip Code:73951-0461
Mailing Address - Country:US
Mailing Address - Phone:580-523-1169
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 461
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:OK
Practice Address - Zip Code:73951-0461
Practice Address - Country:US
Practice Address - Phone:580-523-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist